Sunday, March 21, 2010

Ethics, Politics and Health Care Reform

Now that the House of Representatives has passed the health reform bill, it's a good moment to consider the relationship between ethics and politics.

Wider societal acceptance of the obligation to ensure access to health care for (almost) all represents the key moral achievement for the agonizing political process we've gone through. From the perspective of other economically developed countries the U.S. is late in joining this moral consensus. But at least we're heading in the right direction.

Psychotherapy can help us understand the political theater we've seen. Wise therapists tell us that dealing with resistance to change is the key therapeutic work. Resistance is where the psychological "vested interests" hide out!

The Republicans have played the resistance card brilliantly, especially in their exploitation of the paranoid component of our societal psyche (see here for a discussion of political paranoia). My guess is that a quarter of half of the Republicans believe their "government takeover" message. The rest understand it as a tactic. For the Democrats I'd guess that a similar segment believes that reforming insurance will remake the health system, with the rest understanding that focusing on insurers while making no mention of underuse, overuse and misuse, was politically effective.

In psychotherapy, when the major resistances have been wrestled to the ground, the work of therapy becomes less dramatic. It's all about "implementation" of whatever the change might be. That's where we are now in the health reform process.

At the end of Phillip Roth's hilarious Portnoy's Complaint, a novel in which Portnoy tells his salacious story while lying on a psychoanalytic couch, his therapist says - "now we will begin."

That's where we are in health reform - we've cleared away enough resistance that we can begin!